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Background: Sesamoid position change after distal chevron osteotomy for moderate to severe hallux valgus is not well known in the literature. The objective of this study was to determine whether the sesamoid position changed over 2 years after distal chevron osteotomy for moderate to severe hallux valgus. Methods: Ninety-seven patients who underwent distal chevron osteotomy for moderate to severe hallux valgus were prospectively assessed for 2 years. There were 91 females, and the mean age was 54.9 (SD 10.9) years. The Self-Reported Foot and Ankle Score (SEFAS) was used for functional assessment. Foot pain was assessed by a 0-10 visual analog scale (VAS), and patient satisfaction by a 5-point Likert scale. Radiologically, hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), metatarsal head displacement, and sesamoid position by the AOFAS criteria were analyzed. Patients were classified according to the medial sesamoid position on the first postoperative weightbearing radiograph (1º-WB-Xray) into the reduced sesamoid group (66 patients) and nonreduced sesamoid group (31 patients). Results: All patients were assessed preoperatively and postoperatively at 1 month and 2 years. On the 1º-WB-Xray, IMA was significantly lower in the reduced group ( P = .038), but HVA ( P = .063) and DMAA ( P = .246) were not significantly different. At the final follow-up, no patients in the reduced group had sesamoid position change from 1º-WB-Xray, whereas 8 (25.8%) patients in the nonreduced group had change of their sesamoid positions. The SEFAS was not significantly different between groups preoperatively ( P = .386) or at 1 month postoperation ( P = .064). The final SEFAS, VAS pain, and satisfaction scores were significantly better in the reduced group, although the clinical significance of these changes remains unknown. Conclusion: A nonreduced position of the sesamoids obtained in surgery can cause their increased malposition over 2 postoperative years and statistically less functional outcomes. Level of Evidence: Level II, prospective cohort study.

The learning curve to reach technical proficiency for third-generation percutaneous or minimally invasive chevron and Akin osteotomies (PECA/MICA) is recognized to be steep however it is poorly defined in the literature. This study is a retrospective review of the first 58 consecutive PECA cases of a single surgeon. The primary outcome was the number of cases required to reach technical proficiency as defined by the operation time. Secondary outcomes included radiation exposure, radiographic deformity correction, and complication rates. Between November 2017 and March 2019, 61 consecutive PECA cases were performed with outcome data available for 58 of these (95%). Technical proficiency was reached after 38 cases. Operation time and radiation exposure significantly decreased after this transition point (p.05). There was no difference in complication rate or radiographic deformity correction regardless of position along the learning curve (p.05). In conclusion, the mean number of cases required to reach technical proficiency in third-generation PECA is 38 cases. The complication rate does not correlate to the number of cases performed, therefore surgeons interested in learning minimally invasive surgery can be reassured that there is unlikely to be an additional risk of harm to a patient during the learning curve.

Our aim in this study is to analyze the content and quality of the videos about hallux valgus on YouTube®. The first 50 videos published by typing "hallux valgus" in the search engine on the YouTube® site were analyzed. The number of views of all videos, likes, dislikes, who uploaded the video, video duration, content, watch rate, and how many days it was uploaded were analyzed and recorded. All videos were analyzed with Journal of the American Medical Association (JAMA), DISCERN, GQS, and VPI scores. Six of the videos (12%) were from academic sources, 14 (28%) from commercial product vendors, 13 (26%) by medical animation organizers, 8 (16%) by physicians, 4 (8%) by physiotherapists, 2 (4%) by physical training trainers, 1 (2%) by patients, and last 2 (4%) by trainers. The JAMA mean score of the videos was recorded as 2 (1-4), GQS 3.02 (2-5), DISCERN score 37.56 (26-68), and Video Power Index 41.35 (0-470). The quality of YouTube® videos about hallux valgus is low. The content and quality of health-related information obtained through the Internet are of increasing importance for both healthcare professionals and patients.

Utilizing the mechanical axis can decrease load on the joint and be beneficial when analyzing bony deformities and planning surgical correction with osteotomies. The aim of this study was to identify the normal mechanical axes of the first and second metatarsals and use them to obtain the first/second mechanical intermetatarsal angle (mIMA). The mechanical axis of the first metatarsal was used to obtain the mechanical tibial sesamoid position (mTSP), which provides a mechanical relationship with the sesamoid apparatus. The angular difference between the anatomic and mechanical axis lines (anatomic-mechanical angle [AMA]) was determined for the first metatarsal and for the second metatarsal. The commonly used first/second anatomic intermetatarsal angle (aIMA) and anatomic tibial sesamoid position (aTSP) were also obtained and compared with the first/second mIMA and mTSP. In this retrospective analysis, radiographs of 50 normal feet (40 patients) were assessed. Pearson's correlation coefficients were used to measure reliability between obtained measurements. Mean first/second aIMA was 8.6 ± 3.0 degrees, and first/second mIMA was 8.6 ± 2.6 degrees. First metatarsal AMA was 1.1 ± 1.0 degrees; second metatarsal AMA was 2.0 ± 1.6 degrees. The mTSP was 2.8 ± 1.1, and aTSP was 2.9 ± 1.0. The TSP median was 3 (range, 1-5). Using the mechanical axis method to obtain the first/second mIMA and the mTSP is reproducible and not affected by anatomic changes to the shape of the metatarsal. Unlike the anatomical axis, the mechanical axis does not change, therefore we recommend using the mechanical axis during surgical planning and when obtaining preoperative and postoperative measurements for the long bones of the foot, particularly for forefoot conditions such as hallux valgus.

The purpose of this study is to analyze the short- and long-term results of severe hallux valgus (HV) treated with a L-Reverse osteotomy.Patients treated with L-Reverse osteotomy for severe HV between the years 2006-2015 were included. Patients were evaluated preoperatively, at 3 months and 4 or more years postoperatively. Changes in the HV angle (HVA) and intermetatarsal angle (IMA) were measured. Clinical outcomes were assessed using the AOFAS score.28 patients were included. Pre-operative IMA changed from 18.1° (18-18.9°) to 7° (6.3-8.5°), and HVA from 38.5° (34.5-41.3°) to 10.0° (8.4-11.8°) at 3 month follow up (p 0.005). Long term follow up was of 5.6 (4.9-6.4) years. IMA value was 7.5° (6.1°-8.1°) and HVA was 10.1° (6.7°-16.3°), with no statistical difference with initial correction (p = 0.14). Median AOFAS score was 92.7 (89-4-96.1).L-Reverse osteotomy can achieve correction of HV severe deformities with good outcomes in long term follow up.III.

Percutaneous, implantless basal closing wedge osteotomy (PIBCO) is a new technique for hallux valgus (HV) deformity correction that does not need internal fixation. We present this technique and its short-term clinical outcomes for moderate-to-severe HV deformities.A retrospective review of 162 feet in 114 patients who underwent PIBCO of the first metatarsal (MT1) was conducted. Follow-up averaged 18.5 months. Outcomes were assessed using the visual analog scale (VAS), hallux valgus angle (HVA), intermetatarsal angle (IMA), and radiologic union. Complications were also assessed.Average VAS score improved from 6.2 to 1.0 (P 0.001). HVA improved from 29.8° to 7.6° (P 0.001). IMA improved from 14.5° to 6.3° (P 0.001). A total of 8 major complications were noted (4.9%).Satisfactory HV deformity correction was achieved. However, some instances may require internal fixation in order to avoid complications related to instability and noncompliance of postoperative rehabilitation protocols.

In the present study, we aimed to determine the relationship of HV angle with angles and measurements obtained from lateral and anteroposterior (AP) radiological images of the foot in individuals with HV.The present study had a retrospective design, and the participants consisted of 66 female patients between the ages of 19 and 64 who applied to Orthopedics and Traumatology and were diagnosed with Hallux valgus. Metatarsus adductus angle, metatarsus primus adductus angle, hallux valgus angle, hallux interphalangeal angle, metatarsal break angle, first metatarsal protrusion distance, metatarsal width, talocalcaneal angle, AP Meary's angle were measured on AP view and calcaneal inclination angle, talar declination angle, lateral talocalcaneal angle, first metatarsal declination angle, fifth metatarsal declination angle, navicular height, lateral Meary's angle, tibiotalar angle were measured on a lateral radiograph. The IBM SPSS 21.0. program was used for statistical analysis, and the level of significance was taken as p 0.05.There were statistically significant differences between the right and left feet in MPA and AMA measurements. The results showed that HV angle (HVA) had a weak relationship with MAA and MW, as well as a moderately positive relationship with MPA. However, it had a moderately negative relationship with AMA and a weak negative relationship with HIPA.We believe that in addition to the HVA angle, MPA and AMA angles should be considered in the diagnosis of HV, especially as the HVA angle is moderately positively correlated with the MPA angle and moderately negatively correlated with the AMA angle.

As many as 10% of patients remain unsatisfied after hallux valgus surgery. We explored the effects of patient personality traits and other preoperative patient characteristics on patient-reported outcomes following surgery. Eighty consecutive adult patients (mean age 45 ± 14 years, 91% female [73/80]) undergoing scarf bunionectomy at our practice were prospectively enrolled from January 2016 to January 2017 and followed for 12 months. Predictor variables included preoperative physical and psychosocial complaints (determined via Brief Battery for Health Improvement-2 questionnaire), patient aggression level, and personality traits (extraversion, agreeableness, conscientiousness, emotional stability and openness). Primary outcome measures included the Foot and Ankle Outcome Score (FAOS) with its 5 subscales, and patient satisfaction. Multiple multivariable regression models were used to determine preoperative patient characteristics associated with FAOS outcome and satisfaction at 12 months. Seventy subjects (70/80, 87.5%) completed the study. All patients experienced technically successful surgery. In the multivariable regression analyses, none of the combinations of potentially important predictor variables explained more than 19.8% of the variance in any of the 5 FAOS subscales at 12 months (range: 6.1%-19.8%). Furthermore, no predictor was associated with patient satisfaction in either the univariate or multivariable analyses. We conclude that patient personality traits, aggression level, and self-reported physical and psychological symptoms do very little to predict outcomes in hallux valgus surgery. As healthcare delivery in the United States has increasingly prioritized patient satisfaction, we will need to broaden the quest for predictors associated with our best (and worst) patient-reported outcomes after hallux valgus surgery.

Plantar pressure assessment is commonly performed to identify pathognomonic gait characteristics and evaluate therapeutics against them in people with various foot disorders. Little is known about the reliability and validity of this assessment in people with hallux valgus (HV) per foot region.This study aimed to assess the reliability and validity of the in-shoe plantar pressure measurement method during gait in people with HV and the required number of footsteps, as an intra-subject sample size, to ensure a reliable and valid use of this method.With an inserted disposable insole plantar pressure sensor in shoes, 17 females with HV (HV angle 15°) completed three gait trials over the ground at a comfortable speed. Peak plantar pressure data and its distribution in 15 stance phases on the foot clinically diagnosed with HV in each participant were extracted by dividing the foot into eight regions. The intraclass correlation coefficient per foot region and the number of footsteps required to produce a valid peak plantar pressure and distribution (intraclass correlation coefficient 0.90) were used to measure reliability. Based on the limit of agreement analysis, the coefficient of variation between the averaged value from each incremental footstep (2-14 footsteps) and 15 reference footsteps was calculated.The intraclass correlation coefficient of plantar pressure assessment with the in-shoe sensor was 0.606-0.847 in the eight foot regions in people with HV. Additionally, the number of steps required for a valid assessment ranged from two to nine. Hence, the application of averaged values from more than nine footsteps is recommended for this evaluation.This reference sample size is intended to be used in future studies and clinical settings to determine the efficacy of HV treatment.

Background: The treatment for severe hallux valgus deformity presents a challenge with high risk of complications. Third generation MIS techniques have increased their publications in recent years. The aim was to compare clinical and radiologic outcomes in moderate and severe cases and report minor and major complications. Methods: Retrospective series of cases with prospective data collection of 156 consecutive feet that underwent percutaneous double first metatarsal osteotomy (PEDO) and first phalanx osteotomy between 2008 and 2019 for moderate (hallux valgus angle [HVA] between ≥20 and Results: A total of 156 procedures were performed in 128 patients. Mean age was 54.3 years (SD 14.3) (range, 19-82 years), median follow-up was 22.6 months (range, 12-96 months). Radiographic changes pre- to postoperation were as follows: HVA changed from 38.2 (SD 10.1) degrees to 11.2 (SD 8.3) degrees ( P < .001), IMA from 14.7 (SD 3.2) degrees to 7.9 (SD 3.7) degrees ( P < .001), and distal articular metatarsal angle from 19.7 (SD 6.3) degrees to 8.8 (SD 5.7) degrees ( P < .001) after PEDO technique. Clinical changes pre- to postoperation were as follows: American Orthopaedic Foot & Ankle Society ankle-hindfoot scale scores improved from 47.3 (SD 16.5) to 87 (SD 11.6) ( P < .001) and visual analog scale scores from 5 (2.7) to 0.9 (1.3) ( P < .001). The satisfaction rate was 97% in the total sample. Recurrence rate (HVA ≥20 degrees) was 7.7%. Hallux varus (HVA Conclusion: Clinical and radiographic parameters improved significantly, with a minimum of 12 months of follow-up in moderate and severe hallux valgus. Long experience in percutaneous surgery and specific instruments are needed for this technique. Recurrence was linked to preoperative HVA ≥40 degrees and postoperative tibial sesamoid position; Hallux varus was linked to lateral soft tissue release. Level of Evidence: Level IV, case series.

Background: The minimally invasive chevron-Akin (MICA) technique has already demonstrated efficacy compared with other known surgical treatments for mild to moderate hallux valgus (HV). MICA combines percutaneous osteotomies with the benefits of modern, rigid internal fixation. The aim of study was to evaluate the radiographic parameters, clinical improvement, and potential complications in moderate to severe HV cases, operated using the MICA technique. Methods: Retrospective study including 70 feet with HV operated using the MICA technique. The AOFAS hallux MTP-IP score and radiographics for HV evaluation were applied preoperatively, and after 6 months, 1 year, and 2 years of follow-up. The following radiographic parameters were measured: metatarsophalangeal hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), interphalangeal angle (IPA), and intermetatarsal angle (IMA). Results: The average preoperative VAS pain score was 8.2 ± 1.5, which improved to 1.2 ± 2.2 at 24 months. The mean preoperative IMA was 14.8 ± 3.6 degrees compared with a mean of 7.5 ± 2.1 degrees ( P < .01) at 24 months. The preoperative HVA value averaged 30.4 ± 9.8 degrees and at 6 months postoperatively 11.1 ± 6.8 degrees ( P < .01), which remained stable until measured at 24 months. The mean preoperative DMAA was 16.3 ± 8.6 degrees and at the 6-month follow-up was 7.8 ± 5.4 degrees ( P < .01). The mean preoperative IPA was 7.63 ± 4.4 degrees compared with a mean of 6.28 ± 3.5 degrees ( P > .05) at 24 months. Complications included painful hardware (14.28%), neuropathic pain (2.85%), and loss of correction (4.28%). Conclusion: In this retrospective review from a single center, we found the MICA technique to be an effective procedure for correcting moderate to severe HV, with a low rate of recurrence and an acceptable rate of complications. Patients undergoing the surgical procedure in our series showed a significant reduction in radiographic parameters and a significant improvement in clinical scores, maintaining these results over time. Level of Evidence: Level IV, retrospective study.

Objectives: This thesis wanted to compare the outcomes of two common approaches to the Lapidus arthrodesis in symptomatic hallux valgus, the plantar- and the dorsomedial plating systems quantified by radiological analysis of the deformity and patient-reported outcome measures (PROMs). The hypothesis was that the plantar- plating system is superior to the dorsomedial plating system. Material and methods: This is an observational retrospective study conducted at the alphaMED orthopaedic clinic in Bamberg, Germany, from January 2014 to December 2017. The study included 43 patients treated with the dorsomedial Titanium Lapidus Plating System (AR-8941)® and 34 patients treated with the Plantar Lapidus Plating System® for symptomatic HV deformity. Preoperative measures included clinical and radiological examinations, as well as assessment of HVA and IMA 1-2, AOFAS score, and pain on the VAS. Postoperative measures included clinical and radiological examinations, assessment of the HVA and IMA 1- 2, AOFAS score, pain score on VAS, patient satisfaction, and German school scoring system ranking. Pseudoarthrosis, reoperations and time to full weightbearing were collected. Results: All variables collected pre- and postoperatively including the HVA, IMA 1-2 and AOFAS score, improved significantly upon surgical treatment (P, Ciljevi: Ova disertacija ima za cilj usporediti ishode dvaju uobičajenih pristupa u Lapidus artrodezi kod simptomatskog hallux valgusa, plantarnog i dorzomedijalnog sustava pločica, kvantificiranih radiološkom analizom deformiteta i mjera ishoda izvješćenih od strane bolesnika. Hipoteza je da je plantarni sustav pločica superiorniji u odnosu na dorsomedijalni sustav pločica. Materijal i metode: Ovo je opservacijska retrospektivna studija provedena u ortopedskoj klinici alphaMED u Bambergu, Njemačka, od siječnja 2014. do prosinca 2017. godine. U studiju je uključeno 43 bolesnika koji su liječeni dorzomedijalnim Titanijum Lapidus sustavom pločica (AR- 8941)® i 34 bolesnika koji su liječeni Plantarnim Lapidus sustavom pločica® za simptomatski deformitet HV. Preoperativne mjere uključivale su klinički i radiološki pregled, kao i procjenu HVA i IMA 1-2, AOFAS rezultata i boli na VAS-u. Poslijeoperacijske mjere uključivale su klinički i radiološki pregled, procjenu HVA i IMA 1-2, AOFAS rezultata, ocjenu boli na VAS ljestvici, zadovoljstvo bolesnika i ocjenjivanje operacije prema njemačkom školskom sustavu bodovanja (od 1 do 6), pri čemu je 1 najbolji (najviši, vrlo dobro). Prikupljeni su podaci o pseudartrozi, reoperacijama i vremenu do potpunog opterećenja noge. Rezultati: Sve varijable prikupljene prije i poslije operacije, uključujući HVA, IMA 1-2 i AOFAS rezultate, značajno su se poboljšale nakon kirurškog liječenja (P

Hallux Valgus is an orthopedic deformity of the forefoot region characterized by a lateral deviation of the first toe by more than 15 degrees with a medial deviation of the first metatarsal, often associated with a rotational deformity of the hallux phalanges. The work presented here is part of a broader study. To assess the (mis)alignment of the hallux, computerized photogrammetry was performed with Kinovea® software. Scientific articles about the reliability of photogrammetry for the (mis)alignment of a hallux evaluation are unknown. The main objective of this work is to verify the reliability of intra- and interexaminer evaluations in the assessment of a hallux (mis)alignment using computerized photogrammetry. For the intrarater evaluation, one examiner analyzed an aleatory sample of 40 feet to measure the (mis)alignment of the hallux, repeating the analysis five or fourteen days later. For the interrater evaluation, two examiners analyzed an aleatory sample of 20 feet. An intraclass correlation coefficient (ICC) and paired samples t-test were applied with a significance level of 0.05. Both inter- and intraexaminer-reliability analyses were rated as excellent (ICCs > 0.7), indicating yet another way to assess hallux (mis)alignment by nonradiological means, avoiding the radiation exposure associated with radiographs and the cost associated with the equipment acquisition.

Background: The purpose of the present study was to compare the degree of sesamoid reduction after hallux valgus correction between distal chevron metatarsal osteotomy (DCMO) and S.E.R.I. (simple, effective, rapid, and inexpensive) osteotomy, and to analyze the effects on the recurrence of hallux valgus. Methods: We retrospectively analyzed the foot radiographs of 60 feet (30 DCMO and 30 SERI) treated for hallux valgus from August 2013 to July 2017. Radiographic assessments were performed preoperatively, at early follow-up (at a mean of 3.1 months) and at the most recent follow-up (at a mean of 16.7 months). The location of the medial sesamoid was classified into seven stages, in accordance with the method described by Hardy and Clapham; stage IV or less was defined as the normal position for the medial sesamoid, and stage V or greater was defined as lateral displacement of the sesamoid. The pre- and post-operative hallux valgus angle, 1–2 intermetatarsal angle, and sesamoid position were compared between the two groups. Results: The mean follow-up period was 18.4 (12–36) months in the DCMO group and 15.0 (12–36) months in the S.E.R.I. group (p = 0.108). The radiologic results showed that the hallux valgus angles were not significantly different between the two groups preoperatively and at the early follow-up: preoperatively, they were 28.8 ± 7.7 in the DCMO group and 32.6 ± 9.5 in the S.E.R.I. group (p = 0.101), and they were 10.4 ± 4.0 and 8.7 ± 5.0 (p = 0.148) at the early follow-up, respectively. However, at the most recent follow-up, the DCMO group (13.9 ± 5.6) showed significantly higher hallux valgus angles than the S.E.R.I. group (10.4 ± 6.4, p = 0.030), and there were no differences between the recurrence of hallux valgus in the DCMO group (13%)and that in the S.E.R.I. group (10%) (p = 0.553). There were no significant differences in the 1–2 intermetatarsal angles between the two groups at the early follow-up (6.1 ± 2.5 vs. 4.8 ± 3.1, p = 0.082) and at the most recent follow-up (7.3 ± 2.9 vs. 6.6 ± 3.5, p = 0.408). After hallux-valgus-correction surgery, the stage change of the tibia sesamoid position from the preoperative stage to the initial follow-up was significantly larger in the S.E.R.I. group (−4.4 ± 1.4) than in the DCMO group (−3.4 ± 1.1) (p = 0.003); the changes from the preoperative stage to the last follow-up were also significantly larger in the SERI group (−3.3 ± 1.7) than in the DCMO group (−2.4 ± 1.5) (p = 0.028); however, the changes from the initial follow-up to the last follow-up showed no significant differences between the two groups (+1.0 ± 1.1 in the DCMO group vs. +1.1 ± 1.2 in the S.E.R.I. group) (p = 0.822). The medial sesamoid was laterally subluxated in all the preoperative cases in the DCMO and S.E.R.I. groups. The lateral subluxation of the tibia sesamoid was more frequently observed in the DCMO group (four cases, 13%) than in the S.E.R.I. group (0 cases, 0%) (p = 0.038) at the early follow-up. Conclusion: In conclusion, our results demonstrated that the S.E.R.I. procedure is superior to DCMO in decreasing the hallux valgus angle and showed that the early post-operative reduction in the sesamoids can be a risk factor for the recurrence of hallux valgus.

Minimally invasive surgery (MIS) is currently used to correct hallux valgus deformities. Most studies reporting on MIS techniques to correct hallux valgus deformities included patients with postoperative complications. These reported complications, with an average rate of 23%, had significant negative effects on the clinical outcomes in this patient population. In the present study, a cohort of 63 women who underwent MIS hallux valgus correction was assessed preoperatively and at a mean follow-up of 1.0, 4.7, and 6.5 years using the American Orthopaedic Foot and Ankle Society (AOFAS) scale and the Manchester Oxford Foot Questionnaire (MOXFQ). The main criterion for inclusion in this cohort was a lack of complications during the entire follow-up period. The results showed significant improvements in both AOFAS and MOXFQ scores between the preoperative and 1-year follow-up assessments. By contrast, clinically small and nonsignificant changes were observed among postoperative follow-up values. The number of enrolled patients needs to be increased in future studies, with different surgeons and techniques included. Nevertheless, our study findings will inform patients about the outcomes they can expect over the years if no complications occur.

Postoperative rehabilitation of patients with hallux valgus is just as important, if not more so, than a technically flawless surgical intervention. Carrying out rehabilitation measures is an integral part of the postoperative period, which must be individual for each patient and depend on the volume and type of surgical intervention, the patient's age, and accompanying pathology. Objective. To improvethe results of the recovery of patients after orthopedic surgical interventions on the front part of the foot due to the developed complex system of postoperative rehabilitation. Methods. The articleprovides an analysis of the results of treatment of 70 patients with transversely spread deformation of the forefoot and hallux valgus 1–2 degrees using different approaches to rehabilitation measuresin the postoperative period. The patients were divided into 2 homogeneous groups by age, gender and degree of hallux valgus. Unlike the control group, manual therapy and myofascial massagetechniques were additionally used in the main group. The results. The results of the treatment were evaluated according to the AOFAS scoring scale for the forefoot, which is generally accepted inthe world. In the preoperative period, the average AOFAS score in the main and control groups was 65.4 and 64.7 points, respectively. 45 days after surgery, the average scores were 74.7 and 74.4 points,respectively. After 60 days, the average score in the main group was 92.1 points, and 82.6 in the control group. 3 months (90 days) after the surgical interventions, the average scores practically coincided in both groups and amounted to 93.7 points in the control group and 95.0 in the main group. The patients of the main group resumed their usual activities after 2 months. after the operation onthe front part of the foot, and the control after 3 months. Conclusions. The use of myofascial massage, manual therapy for mobilizing the metatarsophalangeal and interphalangeal joints of the toes with gymnastics to strengthen not only the stabilizers of the foot, but also to restore the bearing capacity of the girdle of the lower extremities and the stereotype of walking, made it possible to obtainnot only a positive functional result, but also to speed up the recovery compared to the control group per month., Післяопераційна реабілітація пацієнтів з hallux valgus не менш важлива, ніж технічно бездоганно виконане хірургічне втручання. Реабілітаційні заходи є невід’ємною частиною післяопераційного періоду. Їх слід підбирати індивідуально залежно від обсягу та виду хірургічного втручання, віку пацієнта, супутньої патології. Мета. Поліпшити результативідновлення пацієнтів після ортопедичних хірургічних утручань на передньому відділі стопи за рахунок розробленої комплексної системи післяопераційної реабілітації. Методи. Проаналізовано результати лікування 70 пацієнтів із поперечно-розпластаною деформацією переднього відділу стопи та hallux valgus 1‒2 ступенів. Хворих розподілили на 2 однорідні групи за віком, статтю і ступенем hallux valgus. Длякорекції вальгусної деформації І пальця стопи застосовано коригувальні діафізарні остеотомії Scarf І плеснової кістки з фіксацією двома гвинтами Герберта. На відміну від контрольноїгрупи, в основній додатково використано методики мануальної терапії та міофасціального масажу. Результати лікування оцінювали за бальною шкалою AOFAS для переднього відділу стопи. Результати. У передопераційному періодів основній і контрольній групах за шкалою AOFAS середні показники дорівнювали 65,4 і 64,7 бала відповідно, через 45 діб після операції — 74,7 і 74,4 бала відповідно, через 60 діб — 92,1 і 82,6 бала. Через 90 діб після хірургічного втручаннясередні показники практично збігалися в обох групах і склали в контрольній 93,7 бала, в основній — 95,0. Пацієнтки основної групи відновили звичну життєдіяльність через2 міс. після операції, а контрольної — через 3 міс. Висновки. Використання міофасціального масажу, мануальної терапії для мобілізації плесно-фалангових і міжфалангових суглобів пальців стоп із гімнастикою для зміцнення не лише стабі-лізаторів стопи, а й відновлення опороспроможності поясу нижніх кінцівок і стереотипу ходьби, дозволило отриматипозитивний функціональний результат, пришвидшити відновлення порівняно з контрольною групою на місяць.

Objective Pronation of the first metatarsal in hallux valgus has recently been discussed among foot and ankle surgeons. This study aimed to evaluate the potential radiographic correction of moderate and severe hallux valgus using the percutaneous Chevron and Akin (PECA) technique. Methods We evaluated 45 feet in 38 patients (mean age 65.3 years old [36 - 83]; 4 men; 34 women; 7 bilateral) who underwent surgical correction using the PECA technique. The radiographic images evaluated were anteroposterior radiographs obtained pre- and postoperatively at least 6 months after surgery, including the metatarsophalangeal angle, the intermetatarsal angle, pronation of the first metatarsal, displacement of the distal fragment, medial sesamoid position and bone union. Results All parameters evaluated showed significant postoperative improvement, including correction of pronation of the first metatarsal (p < .05) and position of the sesamoid (p < .05). There was a union of osteotomies in all feet. No complications were observed, such as screw loosening or necrosis of the first metatarsal head. Conclusion The PECA technique can correct pronation of the first metatarsal in moderate and severe hallux valgus, and other deformity-associated parameters. Level of Evidence IV; Case Series. RESUMO Objetivo A pronação do primeiro metatarso no hálux valgo tem sido um tema de discussão recente entre os cirurgiões de pé e tornozelo. O objetivo deste estudo foi avaliar o potencial de correção radiográfica do hálux valgo moderado e grave utilizando a técnica percutânea de Chevron e Akin (PECA). Métodos Avaliamos 45 pés em 38 pacientes (média de idade 65,3 anos [36 - 83]; 4 homens; 34 mulheres; 7 bilaterais) submetidos à correção cirúrgica pela técnica PECA. As imagens radiográficas avaliadas foram radiografias anteroposteriores obtidas no pré e pós-operatório com no mínimo 6 meses após a cirurgia, incluindo ângulo metatarsofalângico, ângulo intermetatarsal, pronação do primeiro metatarso, deslocamento do fragmento distal, posição do sesamoide medial e união óssea. Resultados Todos os parâmetros avaliados apresentaram melhora significativa no pós-operatório, incluindo correção da pronação do primeiro metatarso (p < 0,05) e posição do sesamoide (p < 0,05). Houve união de osteotomias em todos os pés. Não foram observadas complicações, como soltura do parafuso ou necrose da cabeça do primeiro metatarso. Conclusão A técnica PECA pode corrigir a pronação do primeiro metatarso no hálux valgo moderado e grave, bem como outros parâmetros associados à deformidade. Nível de Evidência IV; Série De Casos.

Background: The Lapidus procedure corrects hallux valgus first ray deformity. First tarsometatarsal (TMT) fusion in patients with hallux valgus deformity using minimally invasive surgery (MIS) is a new technique, but comparative outcomes between MIS and open techniques have not been reported. This study compares the early radiographic results and complications of the MIS with the open procedure in a single-surgeon practice. Methods: 47 MIS patients were compared with 44 open patients. Radiographic measures compared preoperatively and postoperatively were the intermetatarsal angle (IMA), hallux valgus angle (HVA), foot width (FW), distal metatarsal articular angle (DMAA), sesamoid station (SS), metatarsus adductus angle (MAA), first metatarsal to second metatarsal length, and elevation of the first metatarsal. Early complications were recorded, as well as repeat surgeries. Results: The mean follow-up was 82 (range, 31-182) months for the open group and 29 (range, 14-47) months for the MIS group. In both techniques, postoperative measures (IMA, HVA, DMAA, FW, and sesamoid station) were significantly improved from preoperative measures. When comparing postoperative measures between both groups, the IMA was significantly lower in the open group (4.8 ± 3.6 degrees vs 6.4 ± 3.2 degrees, P < .05). Differential between pre- and postoperative measures for both techniques were compared, and the open group was associated with more correction than the MIS group for IMA (12.4 ± 5.3 degrees vs 9.4 ± 4.4 degrees, P = .004) and HVA (25.5 ± 8.3 degrees vs 20 ± 9.9 degrees, P = .005). Wound complication and nonunion rates trended higher in the open group (4 vs 0) ( P = .051). Conclusion: Both techniques resulted in good to excellent correction. However, the open technique was associated with lower postoperative IMA values and more correction power for IMA and HVA, than the MIS.

The issue of performing a hallux valgus operation with the wide-awake local anesthesia with no tourniquet (WALANT) technique has not been evaluated before. The objective of this study was to compare the clinical results of patients who underwent the WALANT technique during hallux valgus operation and patients who underwent the procedure with traditional anesthesia (TA).In this cross-sectional, retrospective study, 34 patients (17 males, 17 females; mean age: 46.1±8.3 years; range, 36 to 62 years) who underwent first metatarsal osteotomy with the diagnosis of hallux valgus disease between November 1, 2018, and June 1, 2020, were divided into two groups according to the surgical approach determined by patient choice: the WALANT group and the TA group. Demographic characteristics, Visual Analog Scale (VAS) scores for pain and anxiety, postoperative satisfaction levels, and complications were recorded.There was no significant difference between the groups in terms of demographic characteristics. The VAS pain score during needle insertion was significantly higher in the WALANT group compared to the TA group (p0.001). Conversely, the VAS anxiety score was significantly higher in the WALANT group compared to the TA group (p0.001). The median follow-up time was 5.4 months (interquartile range, 5-6 months).This is the first study demonstrating that adequate anesthetic efficacy can be achieved with the WALANT technique for the hallux valgus operation. Acceptable pain scores can be achieved with this technique, and costs are reduced.

Loss of correction is frequently observed following hallux valgus correction and is associated with recurrence of a hallux valgus deformity. The purpose of this study was to correlate loss of correction and radiological parameters following distal chevron (Group C) and combined chevron/akin (Group AC) osteotomy. A total of 859 feet were included for analysis and grouped according to treatment with a distal chevron osteotomy alone or a combined chevron/akin osteotomy. Radiographs were evaluated preoperatively, postoperatively, after 6 weeks, 3 months and, if available, at long term follow-up with a mean of 34.2 (range 7.5-155.3) months. With the exception of the proximal to distal phalangeal articular angle (PDPAA), preoperative deformity was comparable between both groups. Significant correction of all examined parameters (p.001) was seen. Loss of correction at 6 weeks with minor deterioration until follow-up was also detected, with group AC somewhat better than Group C. A strong correlation with loss of correction was found for the postoperative hallux valgus angle (HVA) (p.002), intermetatarsal angle (IMA) (p.001), distal metatarsal articular angle (DMAA) (p.002), positioning of the sesamoids (p.002) and joint congruity (p.035) in Group C and for the DMAA (p.033) and HVA (p.046) in Group AC. Multiple postoperative radiological parameters correlated with loss of correction following distal chevron osteotomy. In Group AC only postoperative HVA and DMAA determined loss of correction. Correction of the deformity in Group AC showed greater stability.

This investigation aimed to better understand the complex relationship of common radiographic measurements performed during the perioperative evaluation of the hallux valgus deformity while accounting for interactions and potential interdependence. Several analyses utilizing the first intermetatarsal angle, hallux valgus angle, tibial sesamoid position, Engel's angle, subject age and subject gender were performed with varying independent and dependent variables. The hallux valgus angle (p.001), tibial sesamoid position (p.001), and Engel's angle (p.001) were found to be independently associated with the first intermetatarsal angle. The first intermetatarsal angle (p.001), tibial sesamoid position (p.001), and Engel's angle (p.001) were found to be independently associated with the hallux valgus angle. This suggests that there is significant interdependence of these variables during a preoperative radiographic examination. However, only the change in tibial sesamoid position (p.001) was found to be independently associated with the change in the first intermetatarsal angle following surgical correction, while no studied variables were found to be independently associated with the change in hallux valgus angle following surgical correction. This suggests that correction of the intermetatarsal angle and tibial sesamoid position might not always reliably predict correction of the hallux valgus angle following surgical intervention. It might also suggest that additional procedures beyond metatarsal osteotomies are required to reliably correct the hallux valgus angle in some deformities. It is hoped that this investigation adds to the body of knowledge with respect to the perioperative radiographic evaluation of the hallux valgus deformity.

The objective of this investigation was to evaluate the apparent movement of the hallux proximal phalanx in the transverse plane relative to the second metatarsal following hallux valgus surgery. Pre- and postoperative radiographs of a consecutive series of 45 feet undergoing hallux valgus surgery were analyzed. Significant improvements were observed in the first intermetatarsal angle (12.4 vs 7.5 degrees; p.001), hallux valgus angle (24.3 vs 13.4 degrees; p.001), tibial sesamoid position (4.6 vs 2.7; p.001), and second metatarsal-hallux proximal phalanx angle (80.1 vs 84.6 degrees; p.001). No difference was observed in the distance between the second metatarsal bisection and the medial aspect of the tibial sesamoid (31.7 vs 31.5 mm; p = .756) nor between the second metatarsal bisection and medial aspect of the hallux proximal phalanx base (34.6 vs 34.2 mm; p = .592). Significant differences were observed between the second metatarsal bisection and the central aspect of hallux proximal phalanx base (26.5 vs 23.9 mm; p.001) and between the second metatarsal bisection and the lateral aspect of the hallux proximal phalanx base (19.3 vs 15.4 mm; p.001). A statistically significant difference was observed in the change of distance between the second metatarsal bisection and the medial, central, and lateral aspects of the hallux proximal phalanx base (-0.4 vs -2.6 vs -3.9 mm; p = .002). These results indicate that the hallux proximal phalanx does not translocate in the transverse plane following hallux valgus surgery, but instead pivots about the medial aspect of the joint.

Background: Coronal and sagittal plane deformities of the lesser toes are common yet challenging to treat. Traditional open releases and translational Weil osteotomies can be unpredictable and lead to postoperative stiffness. We present the results of a percutaneous closing wedge extracapsular osteotomy of the proximal phalanx to treat valgus deformity of the second toe. Methods: Thirty-one patients underwent 40 percutaneous osteotomies at a median age of 58.6±9.4 years. Using a small dorsomedial incision, a percutaneous proximal metaphyseal medial closing-wedge extracapsular osteotomy of the second toe is performed, leaving the dorsolateral cortex intact. An irrigated low-speed, high-torque 2- × 8-mm burr is used under image guidance. The osteotomy is then closed to correct deformity and taped for 2 weeks. Patient-reported outcomes and weightbearing radiographs were obtained. Results: Questionnaire data was available for 89.7% (n=35) of cases. Most cases (91.4%) were either satisfied or extremely satisfied with the procedure. Radiographs were available for 90.0% of osteotomies, with a median length from surgery to radiographic follow-up of 1.6 years (range 0.5-6.3; SD ±1.5). Median second-toe valgus angle (STVA) decreased from 16.2±10.7 degrees to 5.0±7.0 degrees ( P < .001) at final follow-up. All osteotomies united with no delayed union. There were no wound complications or infections. We found 2 cases of radiographic recurrence. Conclusion: Percutaneous proximal phalanx base metaphyseal closing wedge extracapsular osteotomies of lesser toes to correct coronal plane deformity is useful adjunct to first-ray corrective surgery and is associated with high levels of patient satisfaction. Level of Evidence: Level IV, retrospective case series

Background: The objective was to evaluate the influence of the postoperative sesamoid position as measured with conventional radiographs on the patient-reported outcome after scarf osteotomy. The hypothesis was that incomplete reduction of the sesamoid would result in a decreased functional outcome. Methods: Eighty-two patients who underwent scarf osteotomy for hallux valgus were prospectively assessed for up to two postoperative years. The Self-Reported Foot and Ankle Score (SEFAS) was used to assess the quality of life, and the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale (AOFAS) for the functional outcome. A visual analogue scale (VAS) assessed pain, and Likert scale for patient satisfaction. Radiologically, hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), and sesamoid position were analyzed. According to the final sesamoid position, patients were classified as normal position (48 patients) and outlier position (34 patients). A power analysis, conventional and logistic regression statistical analysis were performed. Results: At the final follow-up, significant improvements in all clinical scores were observed for both groups (p = 0.001) with no significant difference in AOFAS score (p = 0.413), but SEFAS score (p = 0.023), VAS-pain (p = 0.006), and satisfaction (p = 0.014) were significantly better in the normal group than in the outlier group. There were significant differences between groups in final HVA (p = 0.042) and IMA (p = 0.040). In multivariate analysis, only lower VAS-pain score (OR 0.4, 95% CI 0.2–0.6; p = 0.039) and normal sesamoid position (OR 2.4, 95% CI 1.6–3.2; p = 0.012) were significant predictor of patient satisfaction. Conclusion: At two postoperative years, normal sesamoid position as measured on weight-bearing radiographs was associated with lower pain and better patient satisfaction in patients underwent scarf osteotomy for moderate to severe hallux valgus.

Transfer metatarsalgia is a potential complication of hallux valgus surgery. This study aimed to investigate the shortened first metatarsal length and elevation and to compare groups with and without second transfer metatarsalgia after Scarf osteotomy.The first metatarsal length of 123 feet was measured via the Maestro's method using the metatarsal axial length and the relative second metatarsal protrusion to the first metatarsal. Metatarsal elevation was measured using the first metatarsal angle.Second transfer metatarsalgia occurred after Scarf osteotomy in 11 (8.9%) feet. When baseline characteristics were considered in propensity score matching, the 11 feet were compared with the 33 feet in the control group. The group with transfer metatarsalgia showed a more shortened first metatarsal axial length (-4.1 ± 1.8 mm vs. -2.5 ± 2.2 mm, p = 0.032), a significantly longer relative second metatarsal protrusion (+5.8 ± 2.6 mm vs. +1.2 ± 2.6 mm, p 0.001), and a significantly lower first metatarsal angle (18.1 ± 4.3° vs. 21.5 ± 4.0°, p = 0.012) than the control group postoperatively.To avoid iatrogenic transfer metatarsalgia, first metatarsal length shortening should be minimized to at least less than 4.0 mm. Furthermore, the metatarsal parabola should be retained.

Children with cerebral palsy are highly likely to develop foot deformities, some of which may require surgical intervention. Hallux valgus is a common forefoot deformity which can cause issues with pain, footwear, orthotic splints and soft tissues. It remains unclear what the optimal surgical treatment is for children with cerebral palsy and hallux valgus deformity.To systematically review studies reporting the clinical and radiological outcomes of surgical correction of hallux valgus deformity in children with cerebral palsy.A systematic review of studies published in electronic databases (Medline, Embase, Pubmed and Cochrane library) from inception until January 2021. Keywords related to hallux valgus and cerebral palsy were included.58 studies were identified of which 7 met the criteria for inclusion. 200 feet in 134 patients with a mean age of 13.5 years were included, with a mean follow up period of 43 months. A range of clinical and radiographic outcomes were assessed. A treatment framework for the assessment and management of hallux valgus in children with cerebral palsy based on the published evidence is presented.Non-ambulant children with cerebral palsy with symptomatic hallux valgus should primarily undergo first MTPJ arthrodesis whilst those who are ambulant should undergo first metatarsal osteotomy± soft tissue correction.

Background: Ligamentous Lisfranc instability is commonly missed on unilateral radiographs. However, measurement protocols for bilateral weightbearing radiographs have not been standardized. The primary aim of this study was to investigate the optimal cut-off values for diagnosing Lisfranc instability by evaluating the side-to-side differences of preoperative bilateral weightbearing radiographs among patients with surgically-confirmed ligamentous Lisfranc instability. A secondary aim was to investigate whether the midfoot measurements for detecting Lisfranc injury could also be used in patients with a pre-existing bilateral Hallux Valgus (HV) deformity by evaluating whether the Lisfranc measurements could be affected by a foot deformity as HV. Patients and methods: Patients who underwent surgical repair of ligamentous Lisfranc instability, as well as a separate cohort with bilateral hallux valgus deformity, were included in this multicenter retrospective cohort study. A standardized radiographic measurement protocol was used to assess the midfoot and a receiver operator correlation (ROC) analysis was used to identify the optimal cut-off value for measurements. Interclass Correlation (ICC) scores were calculated to assess the interrater reliability of the Lisfranc area measurement. Results: Forty-seven patients were included in the Lisfranc group with a mean age of 33 (± 15) years and 25 patients were included in the HV group with a mean age of 51 (± 15) years. For the Lisfranc group, measurements that demonstrated a significant side-to-side difference included; increased C1M2 diastasis of 2.4 mm (± 1.4, P2 (± 15, P2 for the C1M2 surface area. The ICC-score for the second C1M2 area measurement was 0.88. Conclusion: Bilateral foot weightbearing radiographs can effectively diagnose ligamentous Lisfranc instability using a standardized measurement protocol. Malalignment of the medial aspect of the second metatarsal base ≥0.3 mm relatively to the intermediate cuneiform offers a high sensitivity, and distance ≥2.1 mm between the second metatarsal base and the medial cuneiform has a high specificity. Intermetatarsal distance between the first and second metatarsal base has a low sensitivity and specificity and should not be used in solitary for diagnosis. Level of evidence: Level III, retrospective comparative study

The objectives of this review were to: 1) describe reasons for lawsuits following primary hallux valgus surgery in France from 2000 to 2020; 2) to compare private and public practice.Civil (private practice) and administrative (public practice) court decisions in France between 2000 and 2020 were collected using the two leading legal data sources (Legifrance, Doctrine).Seventy-two court decisions related to hallux valgus surgery were included. An appeal was filed in 93% of cases. Finally, 70.8% of the verdicts were in favor of the complainants. The average compensation awarded to a plaintiff was €55,333. The main reasons for complaint after hallux valgus surgery were: a failure to provide preoperative information (47.2%), post-operative pain/stiffness (38.9%), and infection (30.6%). A proven lack of information increased the risk of recognizing the occurrence of post-operative pain and stiffness as faulty from 13.3% to 61.5% (p = 0.01), and the average compensation from €25,330 to €76,716 (p = 0.04). The duration of the procedure was about 1.5 years longer in civil proceedings (p = 0.04). There was no significant difference between private and public activity litigation.Clear and adapted patient information and its traceability could be a way to reduce the number of complaints and their consequences in case of disappointing results.

Background Previous studies have determined the videos on YouTube® have misleading information in medicine, however the assessment of the information for hallux valgus surgery is lacking. Methods YouTube® was analyzed using two keywords as ‘hallux valgus surgery’ and ‘bunion surgery’. Once redundancies were eliminated, each video was evaluated for the characteristic as following: duration, number of views, likes and dislikes, days since upload, view and like ratios and video power index (VPI). The quality of the information was evaluated using DISCERN, JAMA and Hallux Valgus Score (HVS). Results A total of 49 videos included. Fair or poor results for DISCERN and HVS (90% and 69% of videos, respectively) were found. No difference was found between video source and quality scores. Number of likes and VPI negatively correlated with all scores (p Conclusions YouTube® had poor quality of information for hallux valgus surgery.

Radiographic measurements are an essential tool to determine the appropriate surgical treatment and outcome for Hallux Valgus (HV). HV deformity is best evaluated by weight-bearing computed tomography (WBCT). The objective was (1) to assess the reliability of WBCT computer-assisted semi-automatic imaging measurements in HV, (2) to compare semi-automatic with manual measurements in the setting of an HV, and (3) to compare semi-automatic measurements between HV and control group.In this retrospective IRB (ID# 201904825) approved study, we assessed patients with hallux valgus deformity. The sample size calculation was based on the hallux valgus angle (HVA). Thus to obtain the 0.8 power, including 26 feet with HV in this study, was necessary. Our control group consisted of 19 feet from 19 patients without HV. Raw multiplanar data was evaluated using software CubeVue®. In the axial plane, hallux valgus angle (HVA), intermetatarsal angle (IMA), and interphalangeal angle (IPA) were measured. The semiautomatic 3D measurements were performed using the Bonelogic®Software. Inter-rater reliabilities were performed using ICC. Agreement between methods was tested using the Bland-Altman plots. The difference between Patologic and Control cases using semi-automatic measurements was assessed with the Wilcoxon signed-rank test. Alpha risk was set to 5% (α = 0.05). P ≤ 0.05 were considered significant.Reliabilities utilizing ICC were over 0.80 for WBCT manual measurements and WBCT semi-automatic readings. Inter and intraobserver agreement for Manual and Semi-automatic WBCT measurements demonstrated excellent reliability.Semi-automatic measurements are reproducible and comparable to measurements performed manually. The software differentiated pathological from non-pathological conditions when subjected to semi-automatic measurements. The development of advanced semi-automatic segmentation software with minimal user intervention is essential for the establishment of big data and can be integrated into clinical practice, facilitating decision-making.

To explore whether modified Chevron osteotomy together with distal soft tissue release would correct moderate to severe HV deformity and what is the minimal clinical important difference (MCID) for objective and subjective evaluating parameters.From March 2018 to January 2019, 40 hallux valgus patients (including moderate to severe) were enrolled in this retrospective study. The cohort included four males and 36 females. The average age at surgery was 50.95 (range 22-75) years. All patients underwent modified Chevron osteotomy together with distal soft tissue release and completed at least one follow-up at clinic. The American Orthopaedic Foot and Ankle forefoot score (AOFAS, forefoot), Visual Analog Scale (VAS), and Foot Function Index (FFI) were all collected before and after surgery. Besides, the hallux valgus angle (HVA), 1st-2nd intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA) were measured both before surgery and at last follow-up. All MCID values were calculated by employing distribution-based method.Thirty-seven patients (92.5%) showed satisfied result at a mean 14.3-month follow-up (range 13-22 month). Two patients complained about residual pain at the bunion, and overcorrection (hallux varus) occurred in one patient. Meanwhile, no patient observed nonunion. Being female, age more than 60, residual HVA deformity (15°), and post IMA more than 9° showed no statistical relationship with the post-operation residual pain (P 0.05). However, high VAS score before surgery (more than 7) showed strong correlation with residual pain (P0.01). The subjective MCID value was 9.50 for AOFAS, 18.92 for FFI, and 1.27 for VAS, respectively.The modified Chevron osteotomy together with distal soft tissue release could achieve a satisfied result for moderate to severe HV deformity at early follow-up. The residual pain was associated with severe pain before surgery (VAS more than 7).

Background: Weightbearing computed tomography (WBCT) 3-dimensional measurements may be reliable in assessing hallux valgus (HV). The objective of this study was to compare 2D and 3D WBCT measurements of the M1-M2 intermetatarsal angle (IMA) in patients with HV and in healthy controls. We hypothesized that 2D and 3D IMA measurements would correlate and have similar reliability in both HV and controls. Methods: Retrospective multicenter comparative study included WBCT scans from 83 feet (41 HV, 42 controls). IMA was measured on digitally reconstructed radiographs (DRR-IMA). 3D angle (3D-IMA) and its projection on the weightbearing plane (2D-IMA) were calculated from 3D coordinates of the first and second metatarsals. Intraobserver reliability and intermethod correlations were calculated using intraclass correlation coefficients (ICCs). Results: Intraobserver reliability was very strong for DRR-IMA (0.95) and 3D-IMA (0.99). Intermethod correlation between the 3 modalities in HV patients ranged from moderate (DRR vs 2D, 0.48; DRR vs 3D, 0.48) to very strong (2D vs 3D, 0.91). Similarly, intermethod correlation in the control group ranged from moderate (DRR vs 2D, 0.56; DRR vs 3D, 0.60) to very strong (2D vs 3D, 0.92). Conclusion: Measurements for IMA are similar using DRR, 3D and 2D projected angles, with very strong intraobserver reliability and moderate to very strong intermethod correlations. This is the first head-to-head comparison between these measurement modalities in HV. Further investigations are warranted before formulating guidelines for the clinical use of 3D angles. Level of Evidence: Level III, case-control study.

The relationship between managing patient expectations and postoperative functional outcomes has been studied widely in other areas of orthopedics, but there is a paucity of information in the foot and ankle literature. The primary objective of the study was to identify the most common patient "expectations" from hallux valgus surgery and establish over what time period postsurgery they would meet those goals. A prospective study of 45 consecutive patients was performed at a single center. This included adult patients (18 years old) that underwent a scarf osteotomy for primary hallux valgus correction. Patients were followed up for 6 months and completed pre- and postoperative Manchester-Oxford Foot Questionnaire and Visual Analogue Scale scores. A separate "expectations" questionnaire was designed and completed assessing the patient's preoperative rehabilitation expectations compared to the actual time taken to achieve those goals. These included 5 domains: pain improvement, return to walking unaided, return to normal foot sensation, return to normal footwear, and return to driving. The postoperative functional scores demonstrated statistically significant improvement postsurgery (p.001). It also highlighted the overall time frame over which the above expectations were met. On average, patients achieved satisfactory pain improvements 1.4 weeks earlier than expected (p.001) along with trends toward an earlier return to driving function of patient expectation (p.05). Patients can thus be reliably informed that their pain symptoms are likely to settle within one month of surgery. This should allow patients to prepare for their rehabilitation more informed, thus facilitating earlier weightbearing and return to function.

Hallux valgus (HV) is a foot deformity characterized by lateral deviation of the big toe and medial deviation of the first metatarsal.This study aimed to shed light on the treatment effects of different interventions and surgical procedures for HV deformity to determine the effectiveness of gait biomechanics correction.English-language searches of the electronic databases were conducted in the Cochrane Library, Web of Science, PubMed, Scopus, and Embase. Gait biomechanics evaluation before and after conservative or operative treatments was essential for inclusion in this review. Methodological quality was assessed by the Institute of Health Economics (IHE) quality appraisal tool. All pooled analysis was based on the random-effects model.Twenty-five articles (1003 participants) were identified in this review. Three studies chose conservative therapies for HV deformity, incorporating foot orthotics and minimalist running intervention, and surgeries were performed in twenty-two studies. For the pressure parameter alteration under the hallux, the effect size (ES) in the conservative treatment subgroup was - 0.95 with 95%CI [- 1.69, - 0.21]. It demonstrated a moderate ES of - 0.44% and 95%CI [- 0.81, - 0.07] in the surgery subgroup. The five operations' peak pressure alteration under the hallux demonstrated a moderate ES of - 0.45% and 95%CI [- 0.54, - 0.36].Both non-operative and operative treatments could achieve the forefoot pressure redistribution, decreasing loading beneath the hallux and first metatarsal regions，However, the treatment effects of surgeries were not very robust. The percutaneous DSTR-Akin technique is recommended as an adequate operative treatment, with a large ES and moderate heterogeneity. The negative gait return effect should be noticed while using Scarf osteotomy, despite positive clinical and radiographic outcomes.

Background: Hallux Valgus is a type of plantar deformation that involves an angular deviation of the big toe, inwards, with respect to the long axis of the foot. This creates a state of chronic inflammation with a formation of protusion on articulation of big toe called bunion. As a consequence, people can lose capacity of deambulation and require the contribution of self-propelled supports. The treatment consists of surgery and use of non-steroidal anti-inflammatory drugs. A familiarity in this condition has also recently been highlighted. Objectives: To demonstrate, how the combined treatment with manual techniques and specific anti-inflammatory, cream is able to resolve plantar deformation without the aid of surgery and without recurrence. Methods: The synergistic combination of three manual techniques, as: Bowen Technique, Reflexology and Su Jok, coupled with a cream containing Glycerol, Camphor and Povidone Iodine, applied on a cohort of 30 patient, divided in 5 groups, was the basis of the clinical application. In order to confirm the efficacy of the preparation, its composition was compared, by Molecular Docking, with normal antinflammatory drugs. Results: The results from molecular docking showed a greater affinity, of the components of the cream, than the classical drugs. Furthermore, the statistic of the reduction of the size of bunions, showed a complete success in the reduction of volume of bunion, without recrudescence. Conclusions: The combined treatment of manual techniques, with the application of a cream, has shown full effectiveness in resolving the Hallux Valgus plantar deformation, without the appearance of recrudescence.

Background: Medial column instability is a frequent finding in patients with flatfeet and hallux valgus, within others. The etiology of hallux valgus is multifactorial, and medial ray axial rotation has been mentioned as having an individual role. Our objective was to design a novel cadaveric foot model where we could re-create through progressive medial column ligament damage some components of a hallux valgus deformity. Methods: Ten fresh-frozen lower leg specimens were used, and fluorescent markers were attached in a multisegment foot model. Constant axial load and cyclic tibial rotation (to simulate foot pronation) were applied, including pull on the flexor hallucis longus tendon (FHL). We first damaged the intercuneiform (C1-C2) ligaments, second the naviculocuneiform (NC) ligaments, and third the first tarsometatarsal ligaments, leaving the plantar ligaments unharmed. Bony axial and coronal alignment was measured after each ligament damage. Statistical analysis was performed. Results: A significant increase in pronation of multiple segments was observed after sectioning the NC ligaments. Damaging the tarsometatarsal ligament generated small supination and varus changes mainly in the medial ray. No significant change was observed in axial or frontal plane alignment after damaging the C1-C2 ligaments. The FHL pull exerted a small valgus change in segments of the first ray. Discussion: In this biomechanical cadaveric model, the naviculocuneiform joint was the most important one responsible for pronation of the medial column. Bone pronation occurs along the whole medial column, not isolated to a certain joint. Flexor hallucis longus pull appears to play some role in frontal plane alignment, but not in bone rotation. This model will be of great help to further study medial column instability as one of the factors influencing medial column pronation and its relevance in pathologies like hallux valgus. Clinical Relevance: This cadaveric model suggests a possible influence of medial column instability in first metatarsal pronation. With a thorough understanding of a condition’s origin, better treatment strategies can be developed.

Background Pes planus is associated with hallux valgus development. This study evaluated the impact of pes planus on clinical outcomes following hallux valgus surgery. Methods 191 patients underwent Scarf osteotomy for hallux valgus. Pes planus angles including talonavicular coverage angle, lateral talus-first metatarsal angle (Meary’s angle) and lateral talocalcaneal angle were measured. The cohort was stratified into control (0°–4.0°), mild (4.1°–14.9°), moderate (15.0°–30.0°) and severe (> 30.0°) pes planus groups according to Meary’s angle. Clinical outcomes were compared at baseline, 6 months and 24 months. Results There were 78 controls, 95 mild and 18 moderate cases of pes planus. Meary’s angle was independently associated with preoperative hallux valgus angle. Pes planus angles were not associated with pain, AOFAS, SF-36 physical or mental scores. All three groups had similar clinical outcomes and patient satisfaction. Conclusion Compared to patients with neutral foot arches, those with pes planus presented with more severe hallux valgus deformity but had similar clinical outcomes following surgical correction.

We examine the technique and radiographic outcomes obtained with triplanar first tarsometatarsal arthrodesis (3D Lapidus) for the surgical correction of hallux valgus (HV). This procedure, apart from correcting angular deformity 1st-2nd intermetatarsal angle, HV angle, etc., is specifically intended to act on first ray pronation and place the sesamoids in their normal position, to alleviate the metatarsalgia often occurring in HV before and after surgery, possibly caused by their abnormal position. This study aims to examine the radiographic outcomes of the 3D Lapidus procedure.Retrospective study of 37 feet operated on from April 2019 to December 2019, with a minimum 1-year follow-up (mean 420 days), using the 3D Lapidus procedure. Radiographic outcomes were evaluated.The intermetatarsal angle decreased from a mean value of 16.42° to 5.62° (p0.0001). The HV angle decreased from a mean value of 32.12° to 8.05° (p0.0001). The preoperative first metatarsocuneiform angle, with a mean value of 21.86°, was null after arthrodesis (p0.0001). The tibial sesamoid position, according to the Hardy and Clapham classification, decreased from a mean value of 4.84 to 1.27 after surgery, within normality (p0.0001).Correction of the deformity in a single plane is generally insufficient. It is necessary to act on the three planes of space to correct the deformity, obtain good outcomes, and avoid recurrence.Radiographic outcomes of triplanar correction with the 3D Lapidus procedure are excellent, achieving statistically significant differences in all parameters studied.

When the symptoms of hallux valgus persist despite nonoperative management, surgical intervention may be considered to improve pain and restore function. Although most patients return to full or near-full activity after surgery, this is not always the case in higher-demand populations. In fact, little is known about the likelihood of a military servicemember returning to running or military duty, which is analogous to a recreationally active adult, after hallux valgus correction.(1) What percentage of military servicemembers are able to return to full duty, including the ability to run 1.5 to 2 miles, 1 year after hallux valgus surgery? (2) What demographic, radiographic, and surgical variables are associated with an increased likelihood of return to full duty?This was a retrospective study of all military servicemembers who underwent surgical correction of hallux valgus deformities at a single tertiary institution from January 2005 to December 2016. We considered military servicemembers who were treated by four fellowship-trained foot and ankle orthopaedic surgeons and who had at least 1 year time-in-service remaining as potentially eligible. A total of 229 people underwent hallux valgus correction during this timeframe, but only 28% (64 of 229) of patients remained eligible: 41% (93 of 229) were excluded because they were not military members, 28% (64 of 229) were ineligible because they had less than 1 year remaining in service, 2% (4 of 229) were excluded because of prior surgery on the ipsilateral extremity, and 2% (4 of 2292) had an incomplete dataset. Interventions included a modified McBride procedure (9% [6 of 64]), distal metatarsal osteotomies (51% [33 of 64]), proximal metatarsal osteotomies (13% [8 of 64]), and Lapidus procedures (27% [17 of 64]). No bilateral procedures were performed. The mean age of our patients was 40 ± 10 years, and the mean BMI was 28 ± 9 kg/m 2 . In addition, 23% (15 of 64) of patients were nicotine users, 38% (24 of 64) were officers, and 45% (29 of 64) were women. The indication for surgery was functionally limiting pain that persisted despite 4 to 6 months of activity modifications, accommodative footwear, and orthotics. Cosmesis was not an indication for surgery. Before surgery, all patients were unable to complete a 1.5- to 2-mile timed run due to pain. The primary outcome measure was the proportion of patients who returned to full duty, which was defined as the ability to complete a 1.5-mile to 2-mile run for a military fitness test in a fixed time allotment, which varies by age and gender, and the ability to perform military-specific physical tasks at 1 year postoperatively. A secondary analysis according to demographic, radiographic, and surgical variables sought to determine any differences between those who did and did not return to full duty; this was assessed using univariable statistical comparisons at a p value of less than 0.01.A total of 28% (18 of 64) of patients who underwent surgery returned to full duty by 1 year after surgery as determined by the ability to complete a time-allotted 1.5- to 2-mile fitness test run. Of the factors we explored, we did not identify any variables associated with return to full duty. We note that our analysis may have been underpowered to detect differences among factors that could be clinically important, like BMI, age, and comparisons of officers versus enlisted servicemembers.Although this study analyzed the functional outcomes of a group of military servicemembers after hallux valgus correction, we believe our findings may also apply to recreationally active adults in the general population. Only a minority of military servicemembers (28% [18 of 64]) returned to duty 1 year after hallux valgus correction, as determined by the ability to complete a timed 1.5- to 2-mile run. We believe surgeons can use the findings of this study to set realistic expectations for recreationally active adults, particularly runners, after hallux valgus correction.Level III, therapeutic study.

The prevalence of hallux valgus increases with age. However, few studies have compared the effectiveness of surgical correction among different age groups. The authors present a retrospective evaluation of the influence of age on clinical outcomes. Patients who underwent corrective surgery for hallux valgus at an academic hospital were stratified into 2 age groups: ≥70 years old (Group 1) and70 years old (Group 2). Following propensity score matching there were 106 patients: 53 patients in each group. Clinical outcomes, quality of life, and satisfaction questionnaires were collected preoperatively and at 6 months and 24 months postoperatively. There were no differences between both patient groups in preoperative biodata and clinical parameters. However, elderly patients had significantly poorer Physical Component Summary scores postoperatively at both 6 months (p = .001) and 24 months (p.001), and significantly poorer American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal- Interphalangeal Scale at 24 months (p = .026). There was no difference between the 2 groups in patient satisfaction rates at 24 months postoperatively (70% vs 85%, p.05). Elderly patients display significant improvements in their clinical scores 24 months postoperatively with no significant difference between satisfaction rates with their younger counterparts. Elderly patients can stand to benefit from hallux valgus surgery.

Background: Failure to identify and correct malrotation of the first metatarsal may lead to recurrent hallux valgus deformity. We aimed to identify the proportion of hallux valgus patients with increased first metatarsal pronation using weightbearing computed tomography (WBCT) and to identify the relationship with conventional radiographic measurements. Methods: WBCT scans were analyzed for 102 feet with a hallux valgus angle (HVA) and intermetatarsal angle (IMA) greater than or equal to 16 and 9 degrees, respectively. Metatarsal pronation angle (MPA), alpha angle, sesamoid rotation angle (SRA), and sesamoid position were measured on standardized coronal WBCT slices. Pronation was recorded as positive. Hindfoot alignment angle (HAA) was assessed using dedicated software. Pearson correlation and multiple regression analyses were used to assess differences between groups. Results: Mean HVA was 29.8±9.4 degrees and mean IMA was 14.1±3.7 degrees. Mean MPA was 11.9±5.8 (range 0-26) degrees and mean alpha angle was 11.9±6.8 (range −3 to 29) degrees. In a previous study, we demonstrated the upper limit of normal MPA as 16 degrees and alpha angle as 18 degrees. Based on these criteria, we identified abnormal metatarsal pronation in 32 feet (31.4%). We found a strong positive correlation between SRA and HVA/IMA ( R = 0.67/0.60, respectively, P < .001). IMA and HAA weakly correlated with MPA and alpha angle (IMA: R = 0.26/0.27, respectively, P < .01; HAA: R = 0.26/0.27, respectively, P < .01). Regression analyses suggested that increasing IMA was the most significant radiographic predictor of increased pronation. In this cohort, there was no correlation between HVA or sesamoid position and MPA / alpha angle (HVA: P = .36/.12, respectively, sesamoid position, P = .86/.77, respectively). Conclusion: In this cohort of 102 feet that met plain radiographic criteria for hallux valgus deformity, first metatarsal pronation was found abnormal in 31.4% of patients. We found a weak association between the IMA and hindfoot valgus, but not the HVA.

The purpose of this study is to evaluate which of the methods selected in patients with moderate or severe hallux valgus a result in a better correction of hallux valgus angle (HVA) and intermetatarsal angle (IMA) in Scarf osteotomy as compared to Chevron osteotomy. Material and methods; In our study, we selected 36 patients, 16 scarf and 20 chevron osteotomies, with all surgical options from skin incision, capsular and bunionectomy to bone reorientation. Deformities of patients were classified as mild, moderate and severe according to clinical and radiological findings. The results were measured using radiographic HVA, IMA and distal metatarsal articular angle (DMAA). Results: No statistical differences were found in HVA, IMA and DMAA between scarf and chevron osteotomy in mild to moderate hallux valgus. In severe hallux valgus, Scarf osteotomy corrected HVA better than Chevron, although this group consisted of twelve patients. Two patients in the Chevron group and three in the Scarf group developed subluxation of the metatarsophalangeal joint. Conclusion: In patients with moderate and severe hallux valgus the results of Scarf and Chevron osteotomy have no specific difference. Change to IMA angle with the subluxation of the first metatarsophalangeal joint some months after operation were the main cause for insufficient correction. We favor the Scarf osteotomy because it is more profitable, with correction of HVA and IMA.

Multiple fixation techniques for first metatarsophalangeal joint arthrodesis have been described with an average fusion rate of 93.5%. This retrospective cohort study assesses the association between crossed screws (vs dorsal plating) and medical comorbidities and the outcome radiographic union. Bivariate tests of association and multivariable logistic regression were employed to assess differences across fixation type and outcomes. We identified 305 patients who underwent a first metatarsophalangeal joint arthrodesis during the study period. Crossed screw fixation was used in 158 (51.8%) patients while dorsal plating (tubular or anatomic locking plate) was used in 147 (48.2%) patients. Dorsal plating was utilized more often in patients with rheumatoid arthritis (p = .019) and history of smoking (p = .044). At 12 weeks post-operatively there were no significant differences in fusion rates between the two groups (crossed screw group = 95.3% vs dorsal plate group (referent) = 93.5%, Adjusted odds ratio (AOR) 1.39, 95% confidence interval [CI] 0.45-4.26). Not smoking was associated with a greater odds of fusion at 12 weeks (96.2% for nonsmokers vs 75.0% for smokers (referent), AOR 0.07, 95% CI 0.02-0.28). Lower body mass index was associated with a greater odds of fusion at 12 weeks (AOR 0.90, 95% CI 0.82-0.99). Surgeons allowed weightbearing earlier with dorsal plate fixation (2 weeks (interquartile range [IQR] 2.6) versus 5 weeks (IQR 2.6) for crossed screw fixation, p = .001). Patients with multiple medical comorbidities were more likely to require revision surgery than patients having 0-1 comorbidities (p.05). Crossed screws can provide an inexpensive yet effective option for first metatarsophalangeal joint arthrodesis.

Introduction Akin osteotomies are commonly fixed with a screw or staple. Hardware-related symptoms are not uncommon. We compared the outcomes and costs of the two implants. Methods We evaluated 74 Akin osteotomies performed in conjunction with first metatarsal osteotomy for hallux valgus. The osteotomy was fixed with a headless compression screw in 39 cases and a staple in 35 cases. We looked at the implant-related complications, removal of metalwork, revision, non-union and cost. Pre- and postoperative hallux valgus interphalangeal (HI) angles and length of the proximal phalanx were measured. Results There was 100% union, no failure of fixation, no revision surgery and no delayed union in either group. The radiological prominence of screws was significant (p=0.02), but there was no significant difference in soft-tissue irritation (p=0.36) or removal of implants (p=0.49). Two cortical breaches (5.8%) occurred in staple fixation and 4 (10.2%) in screw fixation (not statistically significant (NS), p=0.50). The mean improvement in HI angle was 4.3° with screw fixation and 4.1° with staple fixation (NS, p=0.69). The mean shortening of the proximal phalanx was 2.5mm with screw fixation and 2.3mm with staple fixation (NS, p=0.64). The total cost was £1,925 for staple fixation and £4,290 for screw fixation. Conclusions Staple and screw fixation are reproducible modalities with satisfactory outcomes, but screw fixation is expensive. We conclude staple fixation is a cost-effective alternative.

Arthrodesis of the first metatarsal phalangeal joint (MTPJ) is a widely utilized surgical procedure for a wide array of metatarsal pathologies. This study aims to explore the functional limitations following first MTPJ arthrodesis, overall satisfaction and patient's abilities to achieve activities of daily living (ADL). This prospective cohort study assessed functional limitations as well as footwear and lifestyle restrictions using several questionnaires. One hundred and three participants who had a first MTPJ arthrodesis under the care of a single surgeon were recruited. Pre- and postoperative patient-reported outcome measures were recorded. The American Orthopaedic Foot and Ankle Score (AOFAS) and the Manchester-Oxford Foot Questionnaire were also used to further examine functional status. Hallux valgus angle (HVA) and intermetatarsal angle (IMA) were compared using preoperative and postoperative weightbearing radiographs and successful fusion was recorded. Complications were documented and are discussed in detail. The duration of follow-up was more than 12 months. There was one nonunion in the cohort while 2 patients experienced delay to fusion. Approximately 97% of patients were very satisfied with the procedure and their ability to achieve ADLs post operatively. A further 82.5% of patients were able to return to wearing nonadaptive footwear. The mean reduction in HVA and IMA was 21.78° and 6.84°, respectively. This study demonstrates the safe and successful use of a compression screw/locking plate construct for arthrodesis of the first MTPJ. Furthermore, the study provides clear evidence of high levels of functionality after the procedure with statistically significant differences (p value.05) in all 4 facets of the AOFAS questionnaire as well as several notable differences in activity levels and footwear restrictions pre and postoperatively.

Background: Although hallux valgus is known to cause lower-back pain, the association between hallux valgus and spinal degenerative disease remains unclear. Methods: A retrospective cohort study was conducted between 1 January 2000 and 31 December 2015 using data from the Longitudinal Health Insurance Database in Taiwan. After propensity score matching for age, sex, and some potential comorbidities, 1000 individuals newly diagnosed with hallux valgus were enrolled in the study group, while 1000 individuals never diagnosed with hallux valgus served as the control group. Both groups were followed up until 2015 to evaluate the incidence of hallux valgus. Kaplan-Meier analysis was used to determine the cumulative incidence of hallux valgus, while the Cox proportional hazard model was adopted to estimate the hazard ratio (HR) and adjusted hazard ratio (aHR) with 95% confidence intervals (CIs). Results: The incidence densities of spinal degeneration in the hallux valgus and non-hallux valgus groups were 73.10 and 42.63 per 1000 person-years, respectively. An increased risk of spinal degenerative changes was associated with hallux valgus (adjusted HR = 1.75, 95% CI = 1.50–2.05). Age- and sex-stratified analyses showed a significantly higher risk of spinal degeneration in the hallux valgus group. Moreover, sub-outcome evaluations revealed significantly higher risks of spondylosis (aHR = 2.01, 95% CI = 1.55–2.61), intervertebral disorder (aHR = 2.27, 95% CI = 1.62–3.17), and spinal stenosis (aHR = 1.24, 95% CI = 1.47–1.76). There was also an increased risk of spinal degenerative change in those with hallux valgus without surgical intervention (aHR = 1.95, 95% CI = 1.66–2.99, p < 0.001). Conclusions: Hallux valgus was associated with increased risk of degenerative spinal changes and other spinal disorders.

Hallux valgus (HV), one of the most common forefoot pediatric pathologies, is characterized by lateral deviation of the big toe and medial displacement of the first metatarsal bone. Different surgical techniques have been described to correct the deformity, but no consensus has been reached regarding the best surgical option. The aim of this retrospective study was to report the results of the SERI technique in 58 pediatric HV of 45 consecutive patients. Pre- and postoperative VAS, AOFAS score, HVA, IMA and DMAA were collected. Preoperatively 3 patients (5.2%) had a mild deformity, 52 patients (89.6%) had moderate deformity and 3 patients (5.2%) had severe deformity according to Coughlin et al. Mean VAS score decreased from 5.2 ± 2.2 preoperatively to 0.8 ± 0.4 postoperatively. Mean AOFAS score improved from 68.1 ± 6.8 (range 59–75) preoperatively to 96.3 ± 3.2 (range 88–100) postoperatively, mean HVA reduced from 28.4° preoperatively to 13.2° postoperatively, mean IMA decreased from 15.2° preoperatively to 9.5° postoperatively (p < 0.01); mean DMAA decreased from 13.7° preoperatively to 8.2° postoperatively (p < 0.01). SERI technique showed satisfactory results when treating mild to severe pediatric HV deformity. No major complications were reported.

OF BACHELOR THESIS Name, surname: Eliška Soejonová Supervisor: Ing. Kristýna Plevová Title of bachelor's thesis: The use of passive correctors for the treatment of hallux valgus in combination with individual physiotherapy The bachelor thesis deals with the issue of hallux valgus deformity. This static deformity of the foreleg affects almost a third of the world's population and is one of the most common causes of foot pain. The deformity disrupts the kinesiology of the foot, increases the risk of falls and generally reduces the quality of life. Treatment using methods of physical therapy mainly includes active exercise and facilitation of the muscles of the foot. Hallux valgus deformity can also be treated with passive correctors. Objectives: The main objective of the bachelor thesis is the treatment of hallux valgus deformity using a combination of passive correctors and individual physiotherapy. A partial goal is to improve the values of the measured parameters - that is, to reduce pain, increase the activity of the intrinsic muscles and reduce the size of the hallux valgus angle. Methods: As part of the practical part, 3 patients with symptomatic hallux valgus deformity were selected according to the criteria and underwent a 30-day physiotherapy intervention. This consisted of 6 individual...